APPLICATION FOR JANE BEATTIE MEMORIAL SCHOLARSHIP

Attachments: In addition to the information on this form, please attach a one-page (single-spaced) description of the planned scholarly activity and a copy of your curriculum vitae. 

Applicant's Name _______________________________________________________________

Home Institution _______________________________________________________________

Address	_________________________________________________________________
 
_________________________________________________________________

E-mail ____________________________________		Phone ________________________

Current position _______________________________________________________________

Are you a member (or student member) of EADM ?  Yes          No

Nature of proposed scholarly activity (brief description here; attach further details) 

Location(s) of proposed activity ___________________________________________________

Dates and duration of proposed activity _____________________________________________

Please provide an estimated budget for the major expenses associated with the proposed activity, and indicate the source(s) and amount(s) of financial support anticipated from other sources. 

Optional: People we may contact regarding anticipated collaborations. 

Name ________________________________________________________________________

Institution ____________________________________________________________________

E-mail ____________________________________		Phone _______________________

Name _______________________________________________________________________

Institution ____________________________________________________________________

E-mail ____________________________________		Phone _______________________